Kit in hospital with ketones (orig: help please - feeding advice for an increasingly picky eater)

Hi all,

TL/DR: Kit is hungry but won't eat and is increasingly weak/wobbly, and I am increasingly worried that she's not getting enough food.

I've been quiet on here since Kit was diagnosed last December because we got into a pretty good rhythm for the first handful of months with injections and timed feedings (Purina Pro DM pate). In March Kit decided she no longer liked the Purina Pro DM so I switched her to Fancy Feast Classic Pate.

Since then Kit has gotten increasingly picky with her food. We'll go for about a week, maybe two weeks with one brand of food before she turns her nose up at it. I rotate her between Purina Pro DM, Fancy Feast Classic Pate, and also Nutro Feed Clean Perfect Portions. She gets her wet food 4x per day in her autofeeder plus two main meals at her injection times. I leave out about 1/4c Dr Elsey's chicken kibble for her to snack on as well (this is shared with her brother Henry). She gets Churu tube treats and dried chicken treats as before-and-after glucose test incentives.

A couple weeks ago I took Kit for her regular checkup and she was diagnosed with a mild bladder infection was put on antibiotics for a week. She completely lost her appetite and the only thing I could get her to eat was watered down TikiCat Velvet Mousse and Churu tubes (she also got the antibiotic side effects of diarrhea and lethargy). She's been off the antibiotics for a week now, and her interest in the idea of food is back but she's rejected actually eating all food options except for Churu tube treats. I've tried watering down her canned food (all brands), adding Churu on top, mixing in Purina FortiFlora powder, all with decreasing effectiveness. She still goes to her autofeeder right before it opens but she won't eat her food.

I'm worried she's not getting enough food, especially during the day when I'm at work and can't monitor her (I've been getting up in the middle of the night to check on her and try to get her to eat something). As she's gotten pickier with her food, she's also been getting weaker and wobblier in her legs - she's been walking with her back legs flat-footed for over a month, but today I noticed she's started dragging her back toes. Complicating things is her brother Henry who has started eating her food once she's rejected it, which makes it hard to leave out food for just her.

I've emailed the vet but I wanted to check here in case anyone has advice on what I might try to feed her, or you have tips/techniques for a cat who is interested in the idea of food but doesn't like the options. I hit a wall tonight when I opened up every brand of food and she was like "Nope, I just want to eat Churu."

(Just a note to say I'm writing this right before heading to bed, so if there are replies in the next 8 hours or so I won't respond to them until tomorrow morning.)

Thank you,
Emma

 

Hi Emma,

That sounds like nausea to me. I think Kit might be nauseated and if I were you I would get some anti nausea meds from the vet and see if that helps. Ask the vet for some Ondansetron or cerenia. Ondansetron is better for nausea and can be given 3 times a day.

This sounds as if Kit has diabetic neuropathy. This happens to diabetic cats who are not regulated. The treatment is to try and get the BGs back down to normal levels and you can also give a medication called methyl B 12 which you can get from lifeline.com and it is called Zobaline or you can get it locally in the US. I will tag @Diane Tyler's Mom as she knows what it is called in the US and where to get it.

I also think you are holding the dose too long. If you are following SLGS you can increase every 7 days if needed. And Kit definitely needs an increase to 3.25 units.

Here is a link to STIMULATING A CATS APPETITE
I’m not sure how much this will help as I think she need an anti abuses medication.

 

Newman often comes for his food and then just sits and looks at it.

I found that if I crumble Pure Bites freeze dried chicken bites and sprinkle a small amount of the crumbles over the food, he is literally shoving my hand out of the way to eat the regular Fancy Feast pate topped with chicken crumble. Once he gets started he usually eats it all.

I have given Zobline for hind leg weakness. I think it works well, but it does take some time depending on the degree of weakness. It comes in a capsule which can be opened and sprinkled on their food.

 

Thank you Bron and Linda. I will ask my vet about Zobaline and Ondansetron. This morning I tried giving her (all watered down) a little bit of Fancy Feast mixed with lots of Churu, with FortiFlora mixed in and Purebites chicken crumbled on top and she still wasn’t interested. I ended up using a baby spoon and syringe to get some food into her before I left for work. She did eat a whole Churu tube and some of Dr Elsey’s kibble so at least I know she’s eaten something.

My vet is a little on the conservative side when it comes to increasing Kit’s dose because she knows I’m out of the house for work and can’t monitor her during the day since I’m her only caretaker. I will ask her about a dose increase though. When Kit did the big food changeup late March/early April I did notice that her glucose levels went up and they’ve been averaging higher now than earlier this year.

I appreciate your responses and advice!
-Emma

 

For the neuropathy
You can order this Methyl B-12 . I have used it for years and a lot of other members use this Methyl B-12 , just open up the capsule mix it in with the wet food add some water, it's tasteless.

The Zobaline is too expensive

https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6
14.49 for 100 capsules
Give one a day



Once you get Kits BG under control this will help with it also.
Tyler had diabetic neuropathy and it took about 1-2 months and he was back to jumping, running etc.
I did see an improvement every 2 weeks
You can start it now if you want to

 

Thanks for the Vitacost link, Diane. I just ordered some. And it is nice to read that Tyler improved - I miss Kit joining me on the couch, and coming up the stairs with me!

 

Just an update that I took Kit to the vet this morning for an abdominal ultrasound because the vet was concerned about her symptoms. Nothing scary turned up (no cancer/tumors). She did show some enlargement of her liver and pancreas which the vet said are consistent with being diabetic, and she has some thickening of her intestines which the radiologist wants to re-check in 3 months but he thinks they might just be benign polyps.

My vet gave Kit an injection of Methyl B-12 which she said should last about a week, and then I'll start giving Kit the Methyl B-12 pills. The vet also prescribed Cerenia for nausea (8mg pill a day for the next 8 days), and told me if Kit's still not eating by Saturday then she would look into appetite stimulants. Kit also got some subQ fluids.

I bought some Beech Nut baby food (chicken in broth and turkey in broth) and will try giving that to Kit tonight.

Once Kit is more-or-less back to eating normally the vet will have me increase Kit's insulin dose, but she didn't want to increase it while Kit's appetite is still low.

 

Thanks for the update. I am glad there was nothing too bad in the ultrasound.
If the cerenia does not work, you could try ondansetron which is better for nausea then cerenia.
I can see you have given a couple of different doses of insulin over the last few days. Are you going back to the 3 units twice a day for now?

 

My vet gave me general advice to give Kit a 1/2 dose if her preshot was lower than 180; last night her preshot was 187 and she hadn't eaten much all day and was going to be fasting starting at 9pm so I gave her a 2/3 dose since she was so close to the 180 threshold. Specifically for this morning since Kit was fasting the vet wanted me to give her a 1/2 dose. But the plan is to do 3 units twice a day until Kit is eating more normally, then my vet will probably raise the dose a bit.

I'll keep Ondonsetron in mind if the Cerenia doesn't seem to be working. Kit did eat some Purebites dried chicken right when she got home this afternoon, and she ate most of the Beech Nut turkey baby food that I gave her (though I only gave her half a bottle). We'll see what happens overnight for her two timed autofeeder meals...

 

Are you testing for ketones in the urine?
If not I think it would be a very good move to buy some ketostix and test the urine for ketones.
Not eating enough and not getting enough insulin can cause ketones to develop so testing for them is a good idea.

 

I haven’t been testing for ketones but I do have some test strips in my supply box and I’ll see if I can get a sample tonight. Is this something you do daily? Weekly? I am still learning about what they are.

 

I'm stuck again.

Kit hasn't shown any improvement over the last few days, in fact she's rejected even more food options. She won't eat the BeechNut babyfood I bought her and she's even rejecting the PureBites dried chicken. I tried giving her nutritional yeast as a topper a couple days ago which she seemed to like, but tonight with dinner she wouldn't eat it. I even bought a can of tuna for her (in water, no salt) and she wasn't interested. She is licking up a tiny bit of pumpkin right now but her trend is anything she eats one night she won't like the following morning. The only thing she's consistently eaten is Churu tube treats and I don't know how nutritionally practical those are as a main food source (not to mention expensive).

I found the FDMB info page with the recipe for the "liver shake" so I will try that. I ordered some feeding syringes which should arrive tomorrow.

I still haven't hit the right timing to catch her urinating to take a ketone test; I'll update if/when I do that tonight or tomorrow.

I'm going to contact my vet tomorrow and ask about Ondonsetron, ketones, and syringe feeding.

 

Thickening of the intestines is consistent with IBD. Both my cats have/had it and if that’s what she has, ondansetron is what worked. Cerenia never did much. I would try it if I were you.

 

I had a cat with hyperthyroidism who had a neg reaction to the meds. She stopped eating almost completely. I arranged radiation treatment for her but in the meantime my primary concern was getting calories into her.

There's a nutrient dense high cal gel called nutri-cal. You can find it in pet stores or on amazon. So what I did was get a 30 ml feeding syringe. I put a teaspoon of nutri Cal in it along with very smooth cat food. The velvet mouse Tiki would work. I used that and I think natural instinct duck because it was a high call smooth pate. I filled the rest of the syringe with the food and slowly squirted it into her mouth. and a few times a day I feed my cat that way. It was messy but it got her over the bump until she was eating on her own again.

 

Lixit Hand Feeding Syringes for Puppies, Kittens, Rabbits and Other Baby Animals (35ML Pack of 1) https://a.co/d/1jtukpL

 

If she's not eating is more important that she eat SOMETHING even if it's higher in carb.

 

I know it's tough, my cat was doing that too with the wobbly legs. I woke up in the night hearing her flop over on the hardwood floor. The first thing I thought about was that diabetic neuropathy. I thought she was at her end. But she's OK now, 3 weeks latter.

My cat is into her 20th year. She was diagnosed with diabetes in 2009. Now she has renal failure and high blood pressure. So 12 sounds young.

So Daisy and me have been through a lot. I can tell you what is working for us for us, but be cautious with the information.

I wonder what kind of auto feeder you use, does she always eat from that?

I elevate Daisy's food and water bowls on large empty margarine tubs. The saucers and salad style bowls sit securely into the concave margarine tub support. Easier for the cat to eat.

I only feed the various flavors of Fancy Feast. I gave up on the diabetic food a long time ago. I made her some phosphate binders, the commercial versions worried me because of the sucrose content. She eats primarily pates, but keep some gravy versions ready for when she won't eat.

When feeding pate, I squish it flat and add 1 tablespoon of Campbell's brand no salt chicken broth from the box container. (She doesn't like the no name brands as much)

She also likes sockeye salmon juice from the wild red pacific big cans, 2 tablespoons on one elevated saucer.



She also likes 2% lactose free milk, 4 tablespoons on an elevated saucer. Sometimes I crunch up her high blood pressure pill in the milk saucer, she always licks it dry.



And on that elevated milk saucer, she likes just about a tablespoon of Whiskas milk treat.





And she just now has discovered she LOVES these new Fancy Feast Broths drizzled over her pate:


And a teaspoon of nutritional brewers yeast flakes sprinkled over her plate.



It has been grown and used as a nutritional supplement for years. Brewer's yeast is a rich source of minerals -- particularly selenium; protein; B-complex vitamins, and chromium, an essential trace mineral that helps the body maintain normal blood sugar levels.

Daisy also gets vitamins and supplements. B-12 injection, Vitamin D drops.

With diabetes, and now renal failure, I read cats are prone to nausea. Diabetic ketoacidosis. Like how we get acid indigestion.

So I grind up a few Pepcid AC pills which I dispense with a micro measuring spoon I got from amazon.

I do have a tube of the Nutri Cal, but I've only used it for the rare occasions where I've given Daisy too much Lantus.
(That was so scary I keep a big plastic syringe attached to a corn syrup bottle with a rubber band)

I'm afraid the Nuti Cal might have too much sucrose.

Good luck.

 

Kit ate some Churu tubes overnight and a few Churu tubes this morning, and I'm going to pick up an appetite stimulant from the vet and some a/d food today. I got a prescription for Ondonsetron though I think I have to order it online so it'll be a few days before she starts on it which means she'll still be on Cerenia for a bit. And I'm going to blend up the Liver Shake ingredients today so it'll be ready when my syringes arrive.

Ketones testing questions:
I still haven't caught her urinating so I haven't checked for ketones yet (she is drinking and urinating, I just have bad timing). Even though I've read the info pages on ketones I still don't fully understand what they are/when to worry. I have the test strips; I just dip the end in her urine, and then compare the color to the chart on the bottle, correct? The instructions on my bottle say to wait 40 seconds but the Feline Ketoacidosis info page says 15 seconds. My bottle has 6 color blocks ranging from beige to dark maroon and the numbers are in mg/dl (0 ,5, 15, 40, 80, 160) and mmol/L (0, .5, 1.5, 4.0, 8.0, 16). Should I look at the mg/dl number or the mmol/L number? And at which number is the scary point when I have to take her to the emergency vet?

Thanks for the support. I've been so stressed out by this lil kitty.

 

I finally caught Kit urinating! I took pics of the strip at 15 seconds and 40 seconds but I can't figure out how to attach them here (I tried the "upload a file" button but it says I don't have permission). To my untrained eye it looks like she's between the 1.5 and 4.0 mmol/L color squares. Should I worry? (I also send the photos to my vet).

Kit did wobble to her kibble dish all on her own after breakfast and ate some, and when I gave her some dried chicken mixed with nutritional yeast she ate some of that too. And she started mewing for food a little bit ago. Right now she's snacking on more Churu.

 

You must read it at exactly 15 secs. Anything more or less is invalid.

Usually the strips will indicate neg, trace, small, moderate, etc. If she has anything more than “trace” at 15 secs, she need to see a vet immediately.

 

I just caught her right after she peed and tested a puddle and she's at the 1.5 color which is "small" so I guess we're going to the emergency vet today.

 

If you copy the pic you can paste it here. The attachment function doesn’t work. Is small the second color after trace?

The ondansetron rx can be filled at any human pharmacy. You don’t need to order it online.

@Bron and Sheba (GA) wdyt?

 

They should check her blood ketones first. If they show elevations, they should give her fluids and check the rest of her panel. She really needs calories and you will need to find a way to get them in her. Can you syringe feed her? Also, IF she does have DKA, there has to be an infection somewhere and she will need broad spectrum antibiotics.

 

Thank you for the copy-paste trick! Below is the first 15sec test I took around 10am this
morning (my local time is almost 2pm now). When I took another test around 12:15pm and her color matched closest to the 1.5 color. I looked at pictures of a different brand of strips and they listed 0.5 as “trace” and 1.5 as “small” so I decided to not wait to hear back from my regular vet and went straight to
the emergency vet. I’m waiting over an hour now to be seen at the emergency vet so hopefully we’ll get a doctor soon.

 

The pic actually looks like it could be somewhere between 1.5 and 4.0. Good call on going to the ER. See if they can give you a few ondansetron there to take home with you. ERs usually have a lot of meds at hand. The AD is a great option to syringe feed. It’s way smoother than regular wet food and with a little water mixed in, it’s easy to dispense with the syringe. You’ll have to do that until she’s eating again. Minnie had a feeding tube out in because she wasn’t easy to syringe feed while Bobo is so i don’t have to worry about a feeding tube with him.

whatever you do, do not stop giving her insulin. That would make the ketones worse. Hopefully you’ll get some answers there and she’ll be on her way to recovering. I know it’s scary, but you caught it and that’s all that matters now!

 

I agree on that ketone strip if you took the photo at exactly 15 secs. That definitely looks to me like it warranted a vet visit immediately. Please keep us posted.

 

Kit will be taking a spa weekend at the emergency vet until Monday morning when I'll take her to the hospital to see a specialist. Thank you all for encouragement for going to the ER vet today. Hopefully they can give her the right fluids and food to get her through this episode. I also feel like I have a lot more tools for dealing with this if/when it happens again.

 

You acted fast and saved her life. Keep us posted!

 

Can you please share what they told you or are keeping her for? What treatments are they giving her?

One thing I’m concerned about is she needs more insulin. If a kitty has DKA, sometimes they will use a bolus insulin like Humulin R to get the BG down. Did they address her insulin needs? And will they be feeding her? How did her labs looks?

One other thing I noticed is you said her vet gave her a methylB12 injection. While this type of injection exists, it’s not common at vet clinics. Usually to encourage eating or address GI issues, they will give a B12 injection in the common form of cyanocobalamin.

 

They are giving her fluids and food, and will be administering her insulin and doing glucose testing. I don't have results from her labwork yet (blood and ketone). I brought my own insulin (lantus) for them; I don't know if they will change the dose or type of insulin for her ketones. Should I call them about this? They are an emergency-only clinic so they don't have specialists over the weekend.

This is what I'm getting:

 

Are they going to call you with lab results? Usually ERs can run those labs while you are still there. When they call, you can ask what their plan is for her insulin. Occasionally, if a cat has DKA, I will see the ER temporarily stop the Lantus so they can give the bolus insulin more often to try and get the BG down quickly but Kit’s numbers aren’t that high. She just needs a little more insulin.

When she gets home, we really need to work with you on dosing so you aren’t holding doses too long or skipping shots. I’m sorry to say but your vet has not done Kit any favors. We would not have suggested you hold doses for so long that clearly weren’t working.

 

I'll call the ER vet later tonight if they haven't called me first and ask about the insulin dosage. And yes, any help with tweaking dosing in the future would be great to help get Kit's numbers lower. These past couple weeks have been so scary and I really don't want to repeat this, especially today's ketone ordeal. How frequently should I be testing for ketones? Or is it dependent on how Kit is reacting to the insulin?

 

I just talked to the emergency vet. He said Kit's ketones were high (5.9 when 0-3 are normal). Her blood sugar levels were 327 at 4pm and 322 at 7pm (I know that the levels go up when the cat is stressed, Kit is generally in the low-to-mid 200s on my ReliOn Premier meter). They gave her the regular lantus dose (3 units) at her regular time but are giving her a continuous short-acting insulin drip and checking her blood sugar levels every 3 hours and adjusting as necessary. He agrees that her lantus dose is too low and might adjust it to 3.5 units in the morning. He is also going to take another urine sample in case she still has a UTI (she was treated for one 3 weeks ago, so maybe the antibiotics didn't take care of it or maybe she came down with another one) but he isn't putting her on antibiotics yet. He told me that it'll take a few days of her being on fluids to get her ketones back to normal but it is do-able.

One interesting thing he mentioned that I wanted to check with folks here about is that he prefers vetsulin over lantus. He thinks it is more reliable. Though he also said his opinion might be based on the fact that he only sees emergency cats that come in when the lantus isn't working well. I'm curious about people's thoughts on vetsulin vs lantus?

What a day/night. I am snuggling Kit's brother Henry close tonight and keeping my phone ringer on high. I appreciate the support you all have given me on this!

 

I figured they would give her a bolus which is the short acting insulin. We would only raise her dose to 3.25u based on her BGs that you have. It’s good he’s looking for a source for infection.

Vetsulin is a huge step backwards. My guess is he doesn’t really understand how Lantus works. And because many vets don’t fully understand how it works or how to manage the dosing, I can imagine he sees a lot of cats whose Lantus isn’t “working well”. It’s good he recognizes it could be because he only sees a certain subset of Lantus users. If someone does not understand how to use Lantus and dose it properly, it’s not going to work at its optimum but it’s a much, much better insulin than Vetsulin. Vetsulin is a harsh insulin that can drop the BG very suddenly. Lantus is a much gentler insulin.

If you will post every day when she gets home (although we hope you will post daily while she’s in hospital and let us know how she’s doing), we can help you improve the dosing and her regulation.

I would also suggest you start posting in the Lantus/Levemir/Biosimilars insulin support group here where you will learn much more about Lantus.

You should check her ketones once a day when she’s in BGs greater than 200 and a few times a week when she’s below 200. She might be ketone-prone going forward so it’s important to watch them.

I hope you get some rest tonight and we hear good news tomorrow.

 

@egwv

How is Kit today? Be sure you get all her BG readings and doses while she’s in the hospital so you can put them on her SS. I hope she’s much better.

As a suggestion, you will get more “eyes” here to help while she’s in the hospital if you can change the title to something like “Kit in hospital with ketones”. To change the title, click on “thread tools” on your very first post in this thread and then “edit thread”. You can also choose a prefix like a “?” If you have questions. That will get a quicker response but please take it down once the question has been answered.

 

Just to add to what Marje said about Vetsulin, it’s also called caninsulin because it was made for canines who have a much slower metabolism than cats. It’s harsh and short lasting so cats are not protected the full 12 hours. Stick with Lantus it’s the best insulin for Kit. Vets just don’t know how to dose. We follow 2 protocols here. I followed the one called TR and got Bobo in remission last month. He would still be diabetic if I had consulted a vet. I’m not saying all cats will go into remission. Bobo had a few things going in his favor, Minnie never did but she was regulated and recovered from severe neuropathy all thanks to the guidance here.

Minnie was also hospitalized back to back for her IBD and a cardiac arrest. She recovered from both and the support from this forum kept me sane. We’re here for you!

Let us know how she’s doing when you hear from the ER.

 

I just came back from visiting Kit - gave her some snuggles and some food (she tried to crawl into my lap while I was standing, poor boo). The ER clinic says they don't like to force-feed diabetic cats so they called me to suggest I come in to try to get her to eat. She willingly ate a Churu tube treat and I was also able to syringe feed her about 20cc of watered-down a/d food (probably about a 1/6 can equivalent). They increased her lantus dose to 3.5 this morning. The IV insulin dose was 6 overnight but they increased that to 8 this morning. She is also getting Cerenia in the IV. I put some Mirataz ointment in her ear to see if that help stimulate her appetite. They will test her ketone level again today. I forgot to ask about her urine test results so I'll ask about that tonight (I'll probably go in again to give her dinner if she's still not eating willingly). No vomiting, no diarrhea, in fact she pooped while I was there and it was huge and solid so I wonder if she is constipated.

I filled in Kit's spreadsheet with her BG levels - they're not exact on-the-hour so I put the specific times in the notes.

Thank you all for checking in!

 

Usually ERs will put in a nasal tube to feed cats that way. Not sure not force feeding a cat with ketones is they way to go @Marje and Gracie and @Bron and Sheba (GA)? Have they or have you tried the AD food yet? It’s a recovery food and it’s more palatable.

 

She did eat some A/D food from a syringe (I gradually squeezed it into the side of her mouth and went at her pace) and she was licking it from my fingers by the end of the second syringe. Part of figuring out what food she'll eat is also *how* she'll eat it, like she prefers to lap Churu directly from the tube instead of from a plate. So I might try putting the A/D food in a used Churu tube and see if she'll take it that way. I asked and the ER does have A/D food too. When she comes home I'll make up the liver shake and try that too.

 

So glad she seems a little more interested in eating. You could also mix the tube with a little food to get her interested.

 

I’m also glad she’s eating some. When you are seeing ketones, food and water are crucial. Have they discussed her labs with you yet? I was hoping to see what her ketones look like today and if they are diagnosing DKA or just high ketones.

 

Just catching up with what has happened. I'm so glad you got her to the ER quickly and she is showing some interest in food.
I agree it would be good to hear some results from the ER and if she has DKA or high ketones.

 

I’m visiting Kit right now (nice long visit, over an hour of snuggle time). She still won’t eat from the vet techs but she ate all the food I brought with me (40cc of a/d mixed with churu, and a churu tube). She was hungry but needed assisted feeding for the a/d mix. The churu tube she ate on her own and I wish I brought a second one.

Her ketones today were 4.1. Urine test results haven’t come back yet. I asked the doctor about DKA or high ketones and he didn’t understand the question (he says they are the same thing?) — I don’t know enough about ketones either to clarify.

Her BG levels have come down to the low 200s (I will update her spreadsheet when I get home). They haven’t given her the lantus dose yet and will do that after I leave. They are raising that dose to 4 units.

I’m picking her up bright and early tomorrow morning to take her to a different facility to see a specialist and hopefully will have more specific information later tomorrow.

Thanks for following along, I really appreciate knowing there are folks looking out for us!

Edited to add that I was able to spend almost 2 hours snuggling Kit, and I have updated her spreadsheet. The ER clinic isn't administering her lantus at 6am and 6pm so her spreadsheet times might get wonky from here but I will put as much info as I can in her notes.

 

I would discourage them from increasing the Lantus dose already. It takes time to fill the depot from a dose and it seems this vet doesn’t understand how different Lantus works. He should leave the dose at 3.5u for at least 4 cycles and then only raise if nadirs are above 300. They can bring the BG down with the bolus.

Ketones are the precursors to DKA. If you get them under control quickly, provide fluids and food, and address any infection, you can ward off DKA.

I hope there is a specialist that knows more about Lantus, ketones, etc. Usually, they will send you to an internal medicine specialist and I’ve yet to meet one that understood a tenth of what we know here, sadly. But, the ketones need to come down more so it will be interesting how they propose to have that happen. I’m just glad she’s eating for you because that is huge. It doesn’t matter what you get her to eat…the crucial thing is that it’s lots of calories and fluids.

 

I agree with everything Marje has said.
That is so good she is wanting to eat for you.

 

Is DKA a permanent condition, or is it something that can go away with proper management? I keep reading info pages on them but I still don't understand fully. Is Kit going to have another layer of special needs on top of her diabetes?

 

DKA goes away wiht proper management. That means enough insulin to keep BG down and also eating enough.

 

As Larry said, with proper treatment, it can resolve but once a cat has had DKA, it could be prone to another episode so it’s very important to ensure the kitty has the insulin it needs at the correct dose, is hydrated by drinking water or having it added to food, and eats enough calories.

Here is some info on ketones and DKA.

 

I just dropped Kitsune off at the hospital but the internal medicine specialist won't be able to see her until the afternoon. In the pickup/transport/drop off shuffle I didn't get a chance to see her BG readings from overnight. I also didn't feed her, but I left a bunch of syringes of a/d food with the vet techs at the new facility. I'm at work today, but work is closer to the new hospital than home is.

 

Just be aware there are times when they might not have time to spend trying to feed her so if she’s reticent to eat for them, I have found at many places, they don’t pursue it. I’m hoping it will be different where she’s at if they know she has ketones.

 

Just to add a tiny bit to what Marje posted re. the difference between ketones and DKA, with DKA, lab values will change. The cat is usually experiencing metabolic acidosis, bicarbonate and potassium levels are off and magnesium and phosphorus levels may be effected, as well.

 

Going forward, if Kit will be more prone to DKA episodes, do you recommend I get a blood ketone meter? I read the info page on them and I see that the strips are really expensive but I think that might be easier than having the perfect timing to test her urine. She's really good with getting her ear pricked for blood tests. I'm lucky to have enough in my vet savings account for this round of overnight hospital stays but another long hospital stay might clean me out (and I need to keep enough saved for Henry when he eventually has old boy cat issues).

 

If it’s hard to catch her going into the litter box, a blood ketone meter might be better for you.

 

I just talked with the internal medicine specialist and am feeling overwhelmed by it all. I'm just going to list everything that I wrote down from our conversation because I need some time to process it:

Priorities are:
-Identifying what triggered this
-Nutritional therapy

This is what they are initially planning on doing:
-Nasal-gastric tube as syringe feeding does not provide nutrition
-Daily bloodwork
-Ultrasound (they will do a limited one since Kit got a complete one last week at my regular vet)
-Chest xrays to check her lungs and esophagus (check for pneumonia, dilated esophagus)
-GI panel
-Freestyle Libre glucose monitor while she is in recovery
-Hospitalization estimate for 48-96 hours depending on how she does

They are only doing IV insulin while she is there and will wait to restart subQ lantus when she is eating again.

I mentioned that her ultrasound last week showed some enlargement of her liver/pancreas and some thickening of her intestines. He said that the intestines might be a sign of IBD or lymphoma(? I think? I didn't fully write everything down) and that an enlarged pancreas might be pancreatitis which is hard to diagnose the trigger and has a wide range of recovery.

Neuropathy: we will wait for her to come home before starting the B12 since the main priority is getting her appetite back.

He went over feeding tube options:
-Nasal-gastric only while she is in the hospital (I am going ahead with this because she needs nutrition).
-E-tube option if she is still not eating on her own because this can go home with her and stay for months. He said it has to be inserted under general anethesia and that diabetic cats have greater risk of complications such as blood clots and ischemic events (neurological). This is scaring me the most right now.

Her DKA status doesn't have to be perfect for her to go home, just better and regulated (appetite back, insulin levels good).

I asked about high ketones vs DKA and he understood the question. He said the weekend emergency clinic didn't show an acid-base status. Based on her blood ketone level and her electrolytes he's assuming DKA but there is a separate blood test (something to do with glucose/electrolytes/potassium?) but that the initial treatment is the same for ketosis and DKA.

He said that DKA cats have a 50/50 prognosis. With appropriate nutrition and identifying the underlying cause that can go up to 60/40 or 70/30 but it is still very serious.

He did not have her ketone levels for today or her urinalysis report but they will update me every morning and evening.

This has me really rattled. The bill estimate is crazy high but I can't not pay it, but obviously it's hard to think of anything but worst-case scenarios with her needing more than 4 days in the hospital and anesthetic for an e-tube, or that she has pancreatitis/IBD/lymphoma and I'm going to lose her.

Does everything they are doing seem on board with you all? Anything that seems unnecessary, or anything they might have missed or that I should ask about?

I can visit her any time but right now I don't even think I am safe to drive because my whole body is shaking. My parents are picking me up from work and taking my car back to their place (they closer to the hospital than me) but I know they are going to tell me that I'm crazy to spend so much money on a cat. I know that that is my decision to make and that people will judge me for whatever decision I make but Kit is my family and I am responsible for her.

 

My kitty J.D. was about Kit's age when he got DKA. He was in critical condition when I took him to the ER on a Sunday. Very weak, lethargic, and purring loudly. The ER back then was only open when other vets were closed (in the middle of the night, weekends, and holidays). At 6:00am on that Monday morning, they were giving me the choice of two hospitals to transfer him too, both 1.5 to 2 hours away in commute traffic. At 7:00am, we started our journey to the UPenn Vet Hospital. I was just praying he would make the journey, and he did. He was in Critical Care in the beginning. His electrolytes were all off, and he was turning yellow. He was so weak, he couldn't lift his head. They never could find what was causing the DKA. He had to have a couple of blood transfusions. Lots of around the clock care, and he slowly got better and better, and eventually through the days was transferred to 3 other departments (ICU, Internal Medicine, and then some other that I can't remember). I prayed all day and all night every day. I was obsessed. I LIVED to go visit him after work for the limited 20 minute visits that they allowed. He wouldn't eat for them, and each visit after work I would bring his favorite foods and treats. He wouldn't eat them. He was there for 8 and 1/2 days from before Christmas to New Years Eve. I traveled through snowstorms to get to go see him. They kept saying he could get to go home as soon as he would eat. On New Years Eve they said I could come get him with a feeding tube. He came home, and within the first 24 hours he took that feeding tube out and was eating on his own. He was still weak, but getting better. He lived a happy life to 20 years old (8 more years). The vet bill was a lot for me back then, but I have always felt if it was a human (with insurance and all) it would have been 100 times what I paid.

 

It sounds as if this vet knows what he is doing. I think a feeding tube is a very good idea. It probably sounds scary to you but it will be much easier to get food into her until she can eat on her own. You will be able to manage fine with it and it will be much more pleasant for Kit than syringe feeding. And getting plenty of food into her is so important at this stage.
Don’t worry about what others will say about spending money on a cat. Kit is your family and it is your decision. Many of us have that pressure from family and friends. There is no need for you to justify what you are doing. Just say it is your decision and your money. We all support your decision here.

 

Gabby was a DKA survivor. I had my vet and the emergency/internal medicine vet both warn me that she might not survive. She did. The vet hospital got labs twice a day. I would call twice a day to find out what the values were. I'm pretty sure Gabby was eating but it was so long ago I honestly don't remember how her appetite was. I'm pretty sure she came home with an appetite stimulant and I suspect she was given an appetite stimulant in the hospital. She was diagnosed with diabetes at the same time so a lot of what was going on was caught up in the entire process of a just diagnosed diabetic cat who was in the midst of DKA, pancreatitis, and hepatic lipidosis. She was hospitalized for 3 days. I was a wreck. My response to the cost was, "That's what credit cards are for."

 

I agree the vet sounds knowledgeable. Although I don’t get the part about syringe feeding not providing nutrition. Perhaps he thinks it would be difficult to get enough calories in a cat via syringe? I know of people who have syringe fed their cats with chronic kidney disease for years. It takes the right syringe, the right food to go through the syringe, and the right number of calories.

Having said that, it sounds like a feeding tube is warranted in this situation and we’ve seen many DKA cats here come home from the hospital with a feeding tube. Here is some info about feeding tubes. And here is info about living with an e-tube. The person who wrote this makes the Kitty Kollar which is fantastic for cats with e-tubes. You can read about it and order one if it becomes necessary from her website. We have at least one member here who uses a Kitty Kollar to keep the FS Libre on her cat.

When you have time, here is a detailed post on pancreatitis. If she has enlargement of some organs, I wonder if she could have triaditis which is inflammation of the pancreas, liver, and small intestine. I wouldn’t go too far down the IBD or lymphoma rabbit hole right now. To be correctly diagnosed, a biopsy is necessary and that’s not in the cards here. She might just have some inflammation. If, after she is feeling better, she is still showing thickening in her intestines on u/s, you can discuss the options with the IM vet then.

It seems to me he is being very thorough. As I mentioned before, we often see vets pull the kitty off the basal insulin (eg lantus) in favor of a faster acting insulin.

We have had many, many, many cats here survive and thrive after DKA. I can remember one who had it twice and made it through both episodes. We have a lot of info here to help you once you get her home.

And I also agree, don’t let anyone tell you it’s silly to spend the money on her. She’s your baby and you get to decide what’s best for you both. We respect whatever your decision is because she is yours and you know your situation. We are here to support you in any way. Hugs to Kit from all of us and lots of healing light.

 

I just got back from visiting Kit. She was still a bit groggy from being sedated from having her nasal tube put in, but she was alert enough to accept kisses and some gentle snuggles. And she enthusiastically ate two Churu tube treats, though the turned her nose up at some Purina DM wet food. She was going to start nutrition through the NG tube soon so we didn't do syringes of a/d food (or more Churu).

I didn't get too many updates or ask more questions because my brain was too full from the info the doctor told me earlier today. So the only update I have is that they didn't find anything new in her ultrasound (I will clarify tomorrow if "nothing new" means "nothing" or "we saw the same issues with pancreas/liver/intestines and have concerns") and her glucose levels are coming down (I didn't get specific readings/times for today's spreadsheet). I did ask about her ketone level today but the vet tech didn't have that information for me. They are focusing on her appetite.

Just to clarify about the doctor's comment about syringe feeding, in the context of the conversation I think he meant that during the hospital stay when they are really trying to get her appetite up that syringe feeding didn't provide enough nutrition compared to a nasal tube. (This was when he was going over what tube feeding entailed and my first reaction was "oh my god tubes sound invasive and expensive and can we just syringe it instead.")

I'm going to visit again before work tomorrow morning and will post when I get the morning update.

Henry's yelling at me for attention so I should give my other cat some scritches now. Thanks, as always, for the information, questions, and support.

 

That is very good news Kit is eating something, even if she turned her nose up at the Purina DM. Before she comes home I would get a collection of canned food to offer her once she wants to eat again. And she will want to eat again. Most cats after DKA are still nauseated and need an antinausea medication and often an appetite stimulant.
that is good they did not find anything new in the ultrasound and her BGs are coming down.
Make sure the vets give you some ondansetron for nausea to take home.
I am surprised the vet tech didn’t know what the ketone level was now. The number of ketones is very important as well as the appetite.
did they find any infection?
When you bring her home we can help and support you while she recovers. We get a lot of DKA kitties recovering after being in the ER.
We appreciate the updates.

 

All good news and thank you for clarifying the vet’s statement.

Today, when you have a chance, can you please start a new thread? We try to limit thread length to 50 posts and we are past that. Please entitle it something like “Updates on Kit—DKA”. If you can then please copy the link below and paste it in the first post of the new thread, it will be easy for us to come back to this thread if we need to read something. Thank you and I hope you rested and Kit is much better today.

https://www.felinediabetes.com/FDMB...increasingly-picky-eater.278522/#post-3081913

 

Hi all,
New thread is here https://felinediabetes.com/FDMB/thr...th-ketones-help-please-feeding-advice.278753/

 

Thank you!

 

I always used a blood ketone meter. Much easier and you don't have to wait for them to pee.